F03.A11
BillableUnspecified dementia, mild, with agitation
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F03.A11 an HCC code?
Yes. F03.A11 maps to Dementia, Mild or Unspecified under the CMS-HCC V28 risk adjustment model.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for F03.A11
For F03.A11 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F03.A11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F03.A11 is the ICD-10-CM diagnosis code for unspecified dementia, mild, with agitation. Early-stage dementia of unknown type where the patient exhibits agitation or restlessness. F03.A11 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental disorders due to known physiological conditions (f01-f09).
Under the CMS-HCC V28 risk adjustment model, F03.A11 maps to Dementia, Mild or Unspecified (HCC 127) with a community, non-dual, aged base RAF weight of 0.464. F03.A11 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
The 'A' indicates mild severity; document specific agitation behaviors in the medical record. Because F03.A11 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F03.A11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Unspecified dementia, mild, with agitation represents cognitive decline of mild severity with agitation (e.g., restlessness, pacing, verbal or physical aggression), where the underlying cause has not been determined. This diagnosis carries important implications for patient safety, functional status, and caregiver burden. Providers should be queried for a more specific etiology whenever possible, as unspecified dementia may indicate incomplete workup rather than truly idiopathic disease.
Documentation Requirements
- ✓Documentation must specify: (1) the dementia type and underlying etiology — F03 codes should only be used when the provider has not identified a specific etiology
- ✓query the provider to determine if a more specific dementia type can be documented to improve coding accuracy. (2) Severity must be clearly stated as mild based on standardized assessment tools such as the Clinical Dementia Rating (CDR) scale or Mini-Mental State Examination (MMSE). (3) Document specific agitation behaviors such as pacing, verbal outbursts, combativeness, or resistance to care, including frequency and triggers. (4) Document the impact on activities of daily living, need for supervision, and current medication management.
Commonly Confused Codes
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